- Senior Business Analyst with 7 + years of experience with key focus in Healthcare/Insurance Industry and Excellent knowledge about health care industry and claims management.
- Expertise in understanding business needs and defining creative and useful software solutions.
- Excellent analytical and problem solving skills in designing, developing and implementing innovative business processes using new approaches and technology.
- Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end - users, Subject Matter Expert (SMEs) team, Architects, design group development, and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
- Expertise in documenting business requirements (BRD) and functional request document (FRD).
- Worked effectively with the QA (Quality Assurance) team for designing and evaluating Use Case Scenarios, Test Plan, Test System, Test Data and Test Cases for the application.
- Created product requirement document (PRD), functional requirement document, system requirement document & technical design document, Creating Request for Proposals (RFP), creating Requirements Traceability Matrix (RTM).
- Hands on experience with UML modeling, Use Case Documents, Use Case Diagrams, class diagrams, interaction diagrams, activity diagrams, state chart diagrams and documentation of every method and attribute.
- Expertise in Software Development Life cycle (SDLC), Project Life cycle and in Software Development Methodologies including Rational Unified Process (RUP), Waterfall, and Agile
- Sound understanding of comprehensive health reform , the Patient Protection and Affordable Care Act (ACA) and medical claim policies and requirements including benefits, membership, enrollment and implementation.
- Expertise in ICD-9 to ICD-10 Conversion & creating a crosswalk between ICD-9 to ICD-10
- Experience in conducting manual testing, unit, system, functional, integration, regression and User Acceptance Testing (UAT) of systems.
- Experience with the working of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies, Personal Injury Protection (PIP) insurance, billing experience with life and disability in health plans with thorough understanding of CPT coding, UCR, FS, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
- Worked on the HIX Program.
- Experienced in HIPAA compliance, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10.
- Thorough understanding and hands-on working experience with standards of EDI/X12- 270/271 & 276/277, 834, 835, 837
- Experience with QNXT 3.4, QNXT 4.6, Facets 4.71, Inbound & Outbound interfaces, EDI configuration, and data mapping using ANSI X12 4010 and 5010.
- Expertise in maintaining the Requirements Traceability Matrix (RTM) across the Deliverables of a project.
- Good experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Rational DOORS, Crystal Reports.
- Proficiency in preparing Vision Document and User Interface Specification to define system boundary for the project.
- Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI)
- Strong in writing SQL queries and reporting the results to the business team.
- Analytical, methodical and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements.
Operating Systems: Windows 95/98/NT/2000/XP/07, UNIX
Software Methodologies: SDLC, SCRUM, Agile, Waterfall Model, Rational Unified Process (RUP), Rapid Application Development (RAD), IBM Curam, SCC Softlab
Databases: MS Access, SQL Server, Oracle 10g, DB2, T-SQL
Programming Languages: HTML, Java, C/C++, XML
Microsoft Office Suite: MS Project, MS Word, MS Excel, PowerPoint, MS Visio, MS SharePoint
Rational Rose, Requisite: Pro and Use cases
Sr. LIS Analyst/Business Analyst
Confidential, Irving, TX
- Work with new clients to facilitate setup and implementation of Soft Computer LIS
- Assist with SoftLab and TotalQC system customization setup and implementation.
- Guide staff in SoftLab and TotalQC system design processes.
- Visit client site at various points in the project, workflow assessment, file build assistance, Super User training, Pre and Post Live audits, Go-Live assistance.
- Work within a multisite, multi-module environment to assist in coordinating various modules
- Work with implementation specialists of other modules to drive toward meeting the go-live date
- Coordinate with Account Executive regarding meetings and project status
- Assist project manager in managing tasks.
- Assist with functional, integrated, parallel, stress and load testing.
- Participate in weekly multi-module conference calls with Account Executive, Project Manager, key client and SCC team members
- Coordinate and host weekly Lab/TotalQC module conf. calls, prepare agenda, set up conf. line
- Provide training documentation, testing forms and documents to clients.
- Troubleshoot client issues in Lab and TotalQC modules
- Work with programmers to resolve client issues
- Perform review of system setup.
- Update SoftLab system with all technical device additions and changes
- Install and configure LIS system device hardware and software
- Provide SoftLab (LIS) and EPIC (HIS) go-live support for 3 Mayo locations
- Manage end user Network, LIS and Exchange accounts
- Installation and support of network hardware peripherals (workstations, printers and scanners)
- Use SoftLab LIS to build, maintain and enhance functionality for end users
- Information Gathering and Defining Requirements
- Instrument Testing, Instrument Interfaces, Setting up Test Translations
- DI Data Manager - troubleshooting using analyzer trace files
- Set ups of Chemistry, Hematology, Coagulation, Urinalysis, Immunology, Microbiology
Environment: SCC Softlab, HP ALM, Service-Now, LIST-IT, Atlas Reports, MICS Reports, Excel.
Senior Business Analyst
Confidential, Grand Blanc, MI
- Managed project and was involved in resource management.
- Co-ordinated with documenting processes used agile methodology to write the Business Requirements documents and designed Functional specifications.
- Served as a liaison between the internal/external business community and the IT organization in order to provide technical solutions to meet user needs.
- Participated in design review meetings, translated the requirements to the developers, and guided the team when issues related to business requirements arose.
- Worked with Associates, understood the business rules, systems, integrated them into the requirements document, and assisted in generation of test cases and test data.
- Created workflows, data diagrams, and other industry standard documents to represent client’s business processes.
- Prepared documents for business requirements document (BRD), systems requirements specification (SRS), high-level design documents (HLDD), and traceability mapping / matrix with the assistance from the business group, and the IT team members.
- Conducted JAD sessions between the business users, Developers, testers & Subject Matter Experts to resolve bottlenecks.
- Creating Business process diagrams of existing systems, the underlying data and use cases associated with those systems, the problems and limitations associated with both, and the available methods of resolving the identified business issues.
- Used HL7 guidelines and dictionary for defining business rules associated with pre-defined workflows according to business requirements.
- Updated the daily status and participates in the Daily and Weekly status meetings.
- Played an active role in performing of Gap Analysis and its documentation.
- Designed and implemented SSIS packages to translate data from operational systems.
- Work closely with the application development and design team onsite and offshore to resolve technical issues and interact with them to ensure overall quality of the project.
- Prepared graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collateral Diagrams and creation of technical design (UI screen) using Microsoft Visio.
- Met with client to present future functionality of the application, gather information from them to know about their need and send this information to test manager.
- Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
- Drove the daily Defect Triage meetings to ensure the quality product.
- Worked closely with the application development, design, and testing team to resolve technical issues and interacted with them to ensure overall quality of the software.
- Responsible for creating & maintaining Requirement Traceability Matrix in order to track the development and QA process.
- Assisting by determining effective, innovative, and timely solutions to the issues and translate often difficult concepts and issues from business to technology and vice versa.
- Interacted closely with QA to finalize the Test strategies and maintained quality assurance using HP Quality Center.
- Provided production support pre-production and post- production issue management and defect tracking.
Environment: Windows, MS Office 2013 (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, Apache Subversion, Erwin, SSIS, Rational Rose, MySQL, Clear Case, Requisite Pro
Senior Business Analyst
Confidential, New York City, NY
- Conducted Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
- Did affect analysis for changing requirements and coordinated with business users and Project Manager for prioritizing the testing/release of the changes through CAB.
- Work as part of an Agile team to solve problems and deliver projects in a fast-paced environment.
- Helped creating Reports for Claims processing, Provider and Member.
- Prepared the Business requirement Document for the enhancement of the existing services. Wrote TRD for the requirements and RTM for testing and defect tracking.
- Managing and communicating progress status reports on various initiatives for senior management reporting with adhere to global standard policies, procedures and tools.
- Modeled the AS-IS system and performed GAP Analysis for the existing system in order to map it to the TO-BE system.
- Involved in creation of SQL queries for File Compare extracts for ICD 9-10 data.
- Acting as the intermediary between business and technology departments by gathering, interpreting, and analyzing requirements, writing specifications and design documents, and helping to develop solutions for complex business issues.
- Developed the strategy for developing and implementing new EDI (HL7 and X12) interfaces and converting historical clinical and data.
- Worked closely with the development team and assist them in producing a quality code.
- Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.
- Worked on improvement of Claims Reimbursement User Interface for a better experience and in corporate changes as per HIPAA guidelines using the gap analysis.
- Assisting business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.
- Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution.
- Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
- Helps in conducting User Acceptance Testing (UAT), and System Integration testing (SIT) and SWOT analysis.
- Translating business operations and objectives into requirement/design documentation to support the objective of the Project.
- Supporting the analysis and demand challenge of requirements and requirements gathering.
- Performed GAP Analysis for HIPAA 5010 transactions and Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
- Provided SQL queries to developer as source queries to identify the data provided logic to assign.
- Responsible for providing the Data Mapping document and rewrite of the SQL queries from As-Is To-Be and validating the data through SQL.
- Assisted with risk assessment, mitigation and re-planning efforts when necessary.
- Attended install task plan meeting for UAT ensuring all test cases are updated with corrections, documenting the entire testing process along with the lessons learned in the process of testing.
- Lead through UAT procedure & conducted training sessions for the end users along with the necessary documentation.
- Created test plan and facilitated its implementation, create Test cases and assisted manual testing.
Environment: Rational Rose, Rational Requisite Pro and UML, Rational Clear Quest, SQL, Microsoft Visio, Test Director, HP Quality Center, MS Project, ER-Win, MS Office.
Confidential , Colorado Springs, CO
- Identified and validated high potential business opportunities for stakeholders.
- Gathered business Requirements, analyze data/workflows. Defined the scope and progressed from problem Statement to well-documented Designs
- Utilized Rational Req Pro as a user to analyze the business requirements.
- Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
- Worked on MS CRM Dynamics for handling the customer claim inquiries, Validation and case creation.
- Facilitated with JAD sessions with the management groups, vendors, users and the IT Group for open and pending issues to develop specifications.
- Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents and have applied the RUP model throughout the entire development and testing process.
- Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules and information needs, and ensured that critical requirements are not missed.
- Conducted Functional Walkthroughs as well as User Acceptance Testing (UAT) sessions.
- Developed Use Case diagrams with MS Visio and also created Business Flow Diagrams, Activity/State diagrams, and Sequence diagrams, which enabled developers and other stakeholders to understand the business process.
- Created business process workflow diagrams (Activity diagrams) in Rational Rose.
- Worked through Software Development Life Cycle (SDLC) from Requirements, Analysis, Design, and Implementation through Testing.
- Act as a liaison between client and technical solutions/support groups, elicit, document, analyze and validate business processes, systems, and solution requirements.
- Worked as an Interface between the users and the different teams involved in the application development for the better understanding of the business and IT processes.
- Detailed understanding of business functionality and preparing the Functionality Test Plan.
- Conducted iterations, communicated results, and milestone achievements to the stakeholders while keeping the developers closely updated on all documented refinements.
- Interacted with Product Manager and Domain Experts to understand various process plans, business process, and functionality in detail.
- Worked closely with the offshore team to convey Technical and Functional specifications.
- Created and maintained a project schedule using MS Project showing all target dates for deliverables.
- Created and maintained complete development plans that included functional specifications, requirements engineering, Use Case modeling, risk assessment and mitigation, internal and external workflow.
- Extensively used ETL to Extract, Transform and load data.
- Developed Scripts for Regression Testing and System Testing.
Environment: Windows, UNIX, C++, HTML, XML, Rational Rose, Rational Requisite Pro, SQL, MS-Project.
- Conducted user interviews, gathered requirements, analyzed the requirements and managed change requirements by implementing organization change management (OCM) methodology.
- Contracted with the HCFA (Health Care Financing Administration) / Medicare Centers and Medicaid Services to provide quick, easy, and affordable access to the health care service of their choice.
- Improvised HL7 for the exchange, integration, sharing, and retrieval of electronic health information.
- Worked with the UI developer to implement UI and create enhancements to optimize user experience.
- Prioritized system impact analysis for online portal experience development.
- Identified and documented issues, risk and gaps, their descriptions, their impact and provided recommendation and alternatives to develop the application to meet the user requirements.
- Worked in a team to develop use cases for their newly added application layout and understood all the business processes related to newly added layout and designed use cases that helped developers to build application.
- Interacted with the developers on resolving the reported bugs and various technical issues.
- Involved in UAT to confirm that the system under test meets the user needs and provides confidence in its use.
- Worked with development and testing teams to accomplish timely release objectives.
- Written and maintained SQL scripts to extract accurate data for testing different Business scenarios.
- Communicated effectively both verbally and in writing using informal updates, formal presentations, business case documents, and technical documents.
- Created Screen mock-ups and logical data models and worked on reports.
- Identified business needs and assisted in eliciting requirements and document business processes.
- Assisted JAD sessions to identify the business flows and determine whether the EDI X 12 Transaction, Code set and Identifier aspects of HIPAA affect any current or proposed system.
- Performed verification tests to validate the data integrity.
- Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements.
- Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams.
- Assisted with UAT (User Acceptance Testing), developing and maintaining quality procedures, and ensuring that appropriate documentation is in place.
- Used UML diagrams such as activity and use case diagram to document the requirements and ensure creation of high-level business requirements documentation.
- Worked cross functionally with developers, QA and project managers to make sure each data could address their needs.
- Performed verification tests to validate sure integrity of data.
Environment: Agile, Rally, MS. Visio, SQL Server, MS Office Suite, HP Quality Center Automation tool.
Canara Bank, India
- Documented detailed Business Requirements Documents (BRD), Technical Requirement Specifications (TRS) and Functional Requirements Specification (FRS).
- Analyzed the existing system and processed gaps in context of new business changes.
- Acted as liaison between clinical staff and the technical developers conducting and facilitating JAD sessions for the analysis of current and future state processes through interviews, workshops, business process storyboarding, use case evaluation, task and workflow analysis, process modeling and simulation.
- Initiated Use Case Analysis using UML, which provided the framework for potential use case deliverables and their inter-relationships, and allow for maximizing software reuse.
- Facilitated workshops and interviewed various stakeholders like financial analysts and mutual fund heads to gather requests and develop use cases.
- Audited internal financial processes on quarterly basis.
- Closely worked with UI team in the design of screens in accordance with the user-defined requirements.
- Analyzed the requirements of business event in relation to the accounting standards.
- Accumulated system requirements from various departments through surveys and interviews.
- Evaluated the impact of change in the requirements in the transition stage and their contingency plans for the same with the Business plan team.
- Assisted in performing general ledger accounting functions as needed and/or assigned.
- Participated in various meetings and discussed Enhancement and Modification Request issues. Performed Gap Analysis of Client requirements, generated workflow process and necessary documents.
- Prepared all financial statements and schedules for annual audit.
- Maintained traceability matrix throughout the SDLC to ensure complete and comprehensive delivery.
- Developed test plans, test cases and conducted User Acceptance Testing (UAT).
Environment: XML, MS Office Word, Excel, MS Access, Visio, Rational Requisite Pro, Rational Rose, SQL, PL/SQL
- Played a key role in the planning, testing, and implementing system enhancements and conversions.
- Provided key project inputs by working with users in defining the project and system requirements.
- Worked on Hospital data processing for improving database for storing user files.
- Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
- Experience of managing multiple stakeholders across the organization, and in QA integration of systems.
- Involved in detailing project mission, data process flow diagrams, and timelines.
- Worked with SQL queries for data manipulations.
- Assisted in building a business process model using Rational Rose, Requisite Pro and Visio.
- Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
- Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
- Developed strategic partnerships with the business unit to develop a solid knowledge base of the business line, including the business plan, products and processes.
- Research operational procedures and methods and recommended procedures for improvement with an emphasis on automation and efficiency.
Environment: RUP, Rational Rose, Requisite Pro, MS Visio, MS Project, SQL, MS Access, MS Office.